Pathological changes in the eyes during pregnancy. Evaluation of the effectiveness of treatment

A woman's eyes, like all organs and systems, experience some changes during pregnancy and childbirth. Therefore, expectant mothers should be examined by an ophthalmologist twice during the period of expectation of the child. If a woman had certain pathologies of vision even before pregnancy, she is under the constant supervision of not only a gynecologist, but also an ophthalmologist. Consider what happens to the eyes during pregnancy, and what problems with vision may occur.

Eyes during pregnancy

When carrying a child in a woman's body, the level of the hormone estrogen increases. It affects connective tissue, which may lead to a slight elongation eyeball, change vitreous body. As a result, fluctuation intraocular pressure, the appearance of dryness of the cornea. All this contributes to the appearance of “flies” before the eyes, deterioration of vision, and difficulties in wearing contact lenses.

The structure of the eye that is most sensitive to changes is the retina. thin layer nervous tissue, which is located on inside back of the eyeball and absorbs light. Changes that occur in the eyeball and blood vessels sometimes lead to foci of delamination, thinning, areas of dystrophy (malnutrition), and retinal hemorrhages. In most cases, all these changes are not felt by a woman and can only be established during an examination by an ophthalmologist. That's why it's so important not to ignore an eye exam during pregnancy.

Eye problems during pregnancy

Sometimes future mom notices frightening manifestations associated with vision or the condition of the eyes. Most of them are not dangerous and are just a "side" effect of pregnancy.

Edema of the eyelids is quite common in pregnant women, especially often in the morning. For their prevention, a woman needs first of all to reconsider her diet and drink. Reduce the amount of foods in your diet high content salt, as well as enough liquids. If these measures do not help, you should consult a doctor.

The flashing of “dots” and “flies” before the eyes during pregnancy is often explained by vascular disorders, in particular, spasms of the fundus vessels. Therefore, in this case, you should not delay the visit to the ophthalmologist.

Change hormonal balance in the body of a pregnant woman provokes a decrease in the production of tear fluid. This contributes to the appearance of dry eyes, photophobia, a feeling foreign body In eyes. These symptoms usually go away after childbirth.

Increased sensitivity of the cornea during childbearing often leads to significant discomfort when wearing contact lenses. Especially annoying discomfort in the last three months of pregnancy. Experts recommend in this case to temporarily abandon the lenses and use glasses.

Another common eye disease during pregnancy is a spasm of the accommodative muscle, which is located inside the eyes. Symptoms of this pathology are eye fatigue, decreased distance visual acuity, blurred vision. This condition may disappear after childbirth, but in some women it turns into myopia. Therefore, when these symptoms appear, it is better to consult a specialist.

Pregnancy sometimes worsens the condition visual functions with pathologies optic nerve and fundus, as well as myopia. This is due to the large loads on the body, changes hormonal background, circulatory system. Only regular monitoring of pregnant women with these pathologies by an ophthalmologist can prevent possible complications vision.

Features of childbirth with eye diseases

If eye diseases are detected during pregnancy or the woman had vision problems even before conception, the doctor faces the task of right choice method of childbirth. In other words, the doctor decides whether to conduct birth process by caesarean section.

Indications for caesarean section are the following states:

• High degree of myopia in the only functioning eye;
• Complicated rapidly progressive myopia of a high degree;
• A high degree of myopia is associated with obstetric pathology or extragenital pathology (diseases of the cardiovascular, respiratory or digestive systems);
• The appearance during pregnancy of pathological changes in the fundus, such as retinal detachment, optic nerve edema, retinal hemorrhage.

Eye drops during pregnancy

Many women experience eye conditions during pregnancy that require the use of medicines. It is important not to self-medicate while waiting for the child and use only the drugs that the doctor will prescribe. In addition, before using any medications, you should read the instructions for them. You can use those funds, in the annotation to which the safety of admission during pregnancy is indicated.

In the first trimester of pregnancy, it is not recommended to use eye drops containing beta-blockers and carbonic anhydrase inhibitors. It has been proven that these substances adversely affect the fetus. 4.9 out of 5 (23 votes)

Several conditions can be attributed to the causes of vision loss:

• hormonal changes;
• the presence of concomitant extragenital pathology - diabetes mellitus, hypertension, kidney disease;
• development of preeclampsia or eclampsia.

Under the influence of hormones, the elasticity of the sclera increases and, as a result, the anteroposterior size of the eyeball increases. An increase in the size of the eye leads to an increase in myopic refraction.

On a note! Not all women experience an increase in the size of the eyeball. This is due to the fact that some people have a predisposition to such processes. For example, if a woman already has refractive errors, then she has a higher risk of reduced vision than a woman with normal refraction.

The cornea also suffers from the action of hormones - dry eye syndrome may develop. If left untreated, dry eyes can lead to clouding of the cornea.

With uncompensated diabetes the lens swells, as a result of which it changes its curvature and vision is reduced. Enhanced Level glucose in the blood Negative influence on the retina and may also cause corneal edema.

If preeclampsia or eclampsia develops, it is possible even momentary loss vision. Also at severe degrees preeclampsia increases the risk of developing retinal vascular thrombosis, with the development of which there is a significant decrease in visual acuity.

Vision correction in a pregnant woman

Any change in visual acuity must be corrected. During pregnancy, only 2 methods of correction can be used:

• wearing glasses;
• usage .

If the cause of the decrease in vision is any disease, then it is necessary to treat the underlying pathological process.

The preferred method of correction is the use of glasses. Glasses must be selected by an ophthalmologist on an individual basis.

Contact lenses are best used during the day. According to the wearing regime, preference is given to lenses with daily or frequent scheduled replacement (use period up to 2 weeks). When using contact lenses, it is important to follow the rules for storing and wearing them.

If during pregnancy a woman notices that she has begun to see poorly, then it is necessary to visit an ophthalmologist to get new recipe on glasses or lenses.

Will vision be restored after childbirth?

The possibility of restoring vision after childbirth depends on the cause that caused its deterioration, as well as on the degree of changes that have already appeared in the eye.

If the decrease in visuas occurred as a result of stretching of the membranes of the eye, then its recovery after childbirth will not occur. In addition, a rapid increase in the size of the eyeball can lead to the appearance of pathological changes in the periphery of the retina. Therefore, within 6 months after childbirth, it is advisable to undergo an examination by an ophthalmologist.

visual impairment associated with common diseases usually goes away after childbirth. The recovery process may take some time, so you need to see a doctor.

Symptoms of preeclampsia or eclampsia usually resolve within a few days after delivery. But if, against the background of preeclampsia, thrombosis of the retinal vessels occurred, then the deterioration of the condition is permanent. After delivery, intensive treatment of post-thrombotic retinopathy should be continued by an ophthalmologist.

Prevention of visual impairment during pregnancy

TO preventive measures to maintain visual acuity include:

• observance of the visual mode;
• rejection of bad habits;
• early detection and treatment of extragenital pathology that affects the condition of the eyes;
• correctly selected correction in the presence of refractive errors.

Yulia Chernova, ophthalmologist, specially for the site

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Pregnancy - special condition for a woman, which leads to many changes in her body. The eyes are also often exposed various changes, temporary dysfunction caused by processes occurring during this period. Their diseases, in turn, can affect the course of pregnancy and the course of childbirth. It is important to be aware of this mutual influence and take the necessary measures in time.

Eye changes during pregnancy

During pregnancy, the eyes, their condition and functionality may undergo the following changes:

• Edema of the eyelids. As a rule, they occur in the morning and are associated with the diet. You should increase your intake of liquids (preferably pure non-carbonated drinking water or green tea) and reduce salty foods.
• Dry eyes. Often accompanied by sensation of a foreign body in the eye, photophobia ( hypersensitivity to the light). It is caused by a change in the hormonal background and a decrease in the secretion of the lacrimal gland. It disappears after childbirth without additional treatment.
• Flashing "dots", "spots". If this becomes a permanent occurrence, then the problem lies in vascular disorders, in spasm of the vessels of the fundus. Requires immediate referral to an ophthalmologist.
• Concentric constriction. It consists in the fact that a woman ceases to distinguish colors on the periphery of her eyes. This is especially pronounced in the long term of pregnancy. This state quite often accompanies a leak normal pregnancy and goes away after childbirth.
• Spasm of the accommodative muscle. Symptoms: reduced distance visual acuity and some blurring, eye fatigue. It may just be a temporary change that will stop after childbirth, but it can also be a harbinger of myopia. When such changes occur, it is recommended immediate appeal see an ophthalmologist to rule out possible complications.
• Discomfort when wearing lenses. Occurs as a result of increased sensitivity of the cornea. It is especially pronounced in the last trimester, disappears after childbirth. If the discomfort becomes unbearable, it is recommended to abandon the lenses and replace them with regular glasses.

Various changes are often associated with changes in intraocular pressure - it decreases, especially over long periods. The vessels narrow, which leads to all sorts of uncomfortable sensations, a temporary deterioration in the function of vision. Most of them do not require special treatment and disappears without a trace after the end of pregnancy. However, it is also possible pathological changes which may result in retinal detachment, partial or complete loss of vision. Therefore, it is recommended to be checked by an ophthalmologist at the beginning, middle and end of pregnancy. If any discomfort occurs, unusual phenomena etc. you should visit a specialist more often, register if necessary.

Impact on existing diseases

Pregnancy can significantly complicate existing eye diseases. The risk group includes women with pathologies associated with lesions of the lens, retina, ophthalmic nerve, cornea and vascular tract. In order to avoid loss of vision, it is necessary not only to see an ophthalmologist regularly, but also to take appropriate measures during childbirth. It can be a gentle delivery - overlay obstetric forceps to reduce the period of attempts, in severe cases, a caesarean section is performed.

The most dangerous are optic neuritis and retinitis. Ordinary childbirth with such pathologies are contraindicated. A caesarean section is performed, and in particular dangerous cases pregnancy is recommended. For these diseases, constant surveillance from a specialist whose testimony will be the decisive factor.

Impact of eye diseases

In general, eye diseases do not significantly affect the course of pregnancy. However, if they are important role two factors play:

1. Reception medicines . Must be very careful - you need to consult a specialist. A number of drugs may contain substances that are contraindicated during pregnancy, so the intake should be temporarily stopped or replaced with other drugs.
2. The course of childbirth. If there is a risk of retinal detachment or other negative changes due to pregnancy clearance, a caesarean section is indicated. In a number of diseases, experts advise termination of pregnancy in order to avoid complete loss of vision. You need constant monitoring by an ophthalmologist, strict adherence to all medical recommendations.

Myopia and hyperopia, a slight decrease in visual acuity are not potentially dangerous, but they definitely require an ophthalmologist's consultation. You may need additional medication, vitamin therapy, surgical intervention for vision correction.

Eye infections during pregnancy

Infectious eye diseases during pregnancy are potentially dangerous in that they can be transmitted to the fetus and cause pathological changes in the developing organs of vision. These include the very common conjunctivitis, keratitis, purulent infection, scleritis, etc. Depending on the specific disease, the symptoms also differ. The most frequent manifestations:

• Edema of the eyelids
• Painful swelling around the eyes
• Tearfulness
• Purulent discharge
• Redness of the eyes and the area around them
• Pain in temporal region
• Sharp rise body temperature

Any of these manifestations requires immediate treatment to a specialist. Delaying treatment is dangerous because infectious diseases are characterized by rapid progression and can cover the entire body. Self-medication is also contraindicated, since it is very difficult to determine on your own what kind of disease is taking place, how much it progresses, what effect it can have on the body of the mother and child.

For staging accurate diagnosis you need to see an ophthalmologist, a blood test. It is important to make sure that the disease does not have time to be transmitted to the baby. Otherwise, immediate treatment is necessary - untimely elimination can lead to loss of vision in a child, various eye pathologies. In order to avoid the occurrence of infectious diseases, it is necessary:

1. Treat common body infections promptly
2. Touch your eyes as little as possible
3. Observe all rules of personal hygiene
4. Take good care of your contact lenses and glasses
5. Change cosmetics more often and be attentive to her choice
6. Change bed linen regularly
7. Do not come into contact with carriers of the infection

Compliance with these simple rules will help to avoid infectious diseases and their possible complications.

Preparations

At the beginning of the second month of pregnancy, the fetus begins to receive all the substances that enter the mother's body, including medical preparations. Therefore, it is very important to carefully consider the choice eye medicines. Here are some guidelines for selection and admission:

• If you are already taking any medications, tell your doctor . After analyzing the composition of the drug, the specialist will say whether its further use is possible.
• Read the instructions . If you need an urgent medication and there is no way to get a doctor's advice, carefully read the indications and contraindications. Each medication must have an indication of whether it is permissible to take it for pregnant and lactating women. You can first consult with the sellers in the pharmacy.
• Contact a specialist for all questions . If eye drops, vitamins and other drugs cause even the slightest concern, wait with their intake and consult a doctor.

Eye diseases and pregnancy have a great mutual influence. Therefore, pay considerable attention to your condition, follow all the changes, do not neglect the recommendations and visits of specialists. Timely treatment will help prevent the development of pathology or eliminate it.

In the last two decades, one not very pleasant trend has begun to be traced. Enough a large percentage young women become pregnant for the first and subsequent times, having a whole bunch of chronic diseases. Most of these diseases, one way or another, will affect the bearing and birth of a baby, and it is not always possible to endure pregnancy with these diseases without problems. If a woman wants to bear and give birth healthy babies, you should take care of planning pregnancy in advance and find out in advance about the features of the course of pregnancy with your chronic illness. Let's discuss in detail the most frequent groups diseases.

Why is surveillance necessary?
No matter what they say about the ease of pregnancy and its rejuvenating effect, but pregnancy itself is a rather difficult test for the organs and systems of a woman - the kidneys, heart and liver experience double stress, and the nervous and endocrine system, immunity. This is due to the fact that to ensure the best provision of the placenta and through it the baby. nutrients, and the mother's body remains in the background.

That is why it is important that by the time of conception the mother's disease be cured or brought into maximum remission, that is, the organs and systems of her body can work as efficiently as possible. Any chronic illness always, even minimally, but still affects the course of pregnancy, and in addition - there is an inverse pattern - pregnancy itself affects the development of the disease and its course. When planning pregnancies, it is important to list any health problems in your body, this will allow you to refer you to a therapist or subspecialists.

Chronic non-gynecological (they are called extragenital) diseases - this is the pathology that a woman suffered from before pregnancy from childhood or young years, in general, she had this disease for a long time. These women have a high risk of developing pregnancy problems, which is why it is important for them to be observed more carefully and for a long time not only by an obstetrician-gynecologist, but also narrow specialists and a therapist, and it would be better if it is the same doctor that previously treated the woman.

Another serious issue is the intake by the mother in order to treat the disease various drugs, many of which can seriously harm the baby in the doses that the mother takes. Therefore, dose adjustment or replacement of the drug with one that is possible during pregnancy is necessary. In addition, it is necessary to prevent the development of exacerbations of the disease and its complications. which can harm the child.

The ideal option for pregnancy is to plan it step by step in tandem with doctors, carefully treating all the “old wounds” and bringing them to stable remission. This inactive state of the disease is not dangerous for the development of the fetus. Unfortunately, we often encounter already pregnant women who have chronic pathologies, and in best case they come to register - at worst - they end up with pregnancy and an exacerbation of the disease in a hospital. At the same time, our medical task is to save the life and health of the fetus, completely curing the mother.

At the same time, I note that not all diseases and conditions forbid getting pregnant and giving birth to children, most health problems and chronic sores completely allow you to give birth to healthy children. However, pregnancy chronic pathology- it is always a risk and it is worth "laying straws", being examined and actively observed, following all the recommendations.

When will we respond?
There are situations when pregnancy and childbirth can become deadly for a woman, and then doctors will strongly recommend that you abandon the idea of ​​\u200b\u200bpregnancy. However, they will tell you about all the dangers, but they have no right to forbid you to give birth, if you decide to risk your life and the life of the fetus, doctors will monitor you day and night.

Pregnancy is dangerous when:
- heavy combined vices hearts with impaired blood circulation, shortness of breath, edema and arrhythmias.
- with severe hypertension With sharp violations circulation,
- with lung diseases that occur with severe respiratory failure,
- with chronic kidney failure in the final stages of renal disease.
- with scleroderma or systemic lupus erythematosus, rheumatic diseases,
- with severe endocrine diseases- diabetes mellitus, thyrotoxicosis, adrenal insufficiency.
- with leukemia and malignant tumors,
- with hereditary metabolic disorders,
- with epilepsy,
- with cirrhosis of the liver.
In such cases, by the decision of the woman and the agreement of the medical council of doctors, she can be offered surgical sterilization, since getting pregnant for her can be deadly.

There is also a group of temporary contraindications for pregnancy - these are factors that can later be eliminated with active treatment and rehabilitation. It is usually not recommended to become pregnant during an exacerbation of the disease and when infectious processes. Pregnancy is not allowed a year after abdominal surgery or very sudden weight loss, after chemotherapy or radiation, when taking very serious drugs that are dangerous to the fetus. Your doctor will tell you the time you need to wait before pregnancy.

Pregnancy in diseases of the heart and blood vessels.
The heart and blood vessels are necessary to sustain life - blood flows through them. The course and outcome of any pregnancy depends on the condition of the heart. If a woman has heart problems or vascular system, she needs to see a cardiologist before pregnancy and during all 40 weeks.

Serious diseases in the heart and blood vessels are associated with high risk for the health of both, however, it is quite possible to endure and give birth to a healthy baby - however, both obstetricians and cardiologists will immediately follow you - each in their own field. If the first signs of a violation of well-being and heart function suddenly appear, they will immediately be placed in a specialized perinatal center at any stage of pregnancy. Cardiologists, together with obstetricians, will also decide on the method of childbirth - whether it is possible to give birth on her own or is it better to do a CS.

If a woman has heart defects, pregnancy is possible and the decision on its management is made together with a cardiologist even in the early stages. Cardiac disorders can occur during critical periods of pregnancy - in the early period up to 12 weeks, and then at about 28-32 weeks, when the load on the woman's cardiovascular system increases dramatically. Another critical period the time may become immediately after childbirth - after all, this is a sharp change in the load and blood circulation.

Why are decompensated heart defects dangerous? These are usually late toxicoses - preeclampsia and the development of fetal hypoxia, this is a risk premature birth and intrauterine death of the fetus, delays in its development and the formation of its diseases. Therefore, before planning a pregnancy, you need to undergo an examination and establish the severity of the defect and its compensation, that is, how well the body copes with impaired blood flow and stress.

A woman will have a lot of examinations - blood tests - general and biochemistry, blood for coagulation, and besides this, an ECG, PCG and ultrasound of the heart are mandatory, this will allow you to evaluate the work of the heart and its structure. If a heart defect is acquired due to rheumatism, then everything will depend on the severity of the defect and on what stage the rheumatism is in, whether there is heart failure and how the woman turns gray and feels herself in life.

Today you can plan a pregnancy a year after the correction of the defect surgically, however, if a woman has artificial valves heart, she will be examined in detail in the hospital three times during pregnancy - at twelve weeks they will examine the condition of the heart and the functioning of the valves, they will choose drug therapy that is safe for the fetus, they will evaluate drug therapy and they will correct it based on the size of the fetus and the load, and after 36 weeks they will put the woman in to prepare for childbirth and decide on the method of delivery - whether the woman can give birth herself or is it worth having a caesarean section.

In the presence of high blood pressure the issue is resolved with a cardiologist, usually pregnancy and childbirth are quite acceptable, it is impossible only with pressure figures above 200 to 115. The danger of such a pregnancy is in the development of preeclampsia, placental abruption and intrauterine fetal growth retardation, the formation of chronic oxygen starvation and therefore, close monitoring of the woman throughout the pregnancy is necessary. Usually women undergo planned hospitalizations with examinations in each trimester - as well as with defects, in early dates decide on the preservation of pregnancy, and then it is decided which drugs and tactics of women are chosen. With an increase in pressure, you can give birth on your own, only they do epidural anesthesia.

With reduced pressure, you can become pregnant and give birth, only drugs will be needed to stabilize the pressure, during pregnancy there is usually a tendency to lower it. In severe hypotension, hypoxia can form in the fetus, which leads to impaired growth and development. Then the risk of miscarriages and IUGR increases, such women are constantly monitored by doctors. Childbirth usually takes place on its own - with the use of anesthesia.

Also, vision problems during pregnancy sometimes occur in absolutely healthy women. To avoid serious consequences, which can threaten not only you, but also the baby, it is very important to be examined by an ophthalmologist in a timely manner and take care of your own vision.

Complications of eye diseases during pregnancy

During pregnancy, the course of eye diseases associated with damage to the lens and cornea, as well as the vascular nerve and retina, is often complicated. Pathologies of the retina and optic nerve are considered one of the most difficult in pregnant women. Most often, their manifestations are associated with nephritis or severe preeclampsia. Unfortunately, when optic neuritis is detected, termination of pregnancy is indicated. Similar measures are required for retinal detachment, regardless of the cause of this phenomenon.

Other common ophthalmic disease is myopia. In an uncomplicated pregnancy, worsening of the course of the disease, as a rule, does not occur, but the progression of the pathology is possible if you experience early or late toxicosis. Visual impairment in myopia is associated with a decrease in intraocular pressure and circulatory deficiency. If you have already been diagnosed with myopia, it is recommended to approach pregnancy planning very responsibly, after consulting with a specialist.

Throughout the entire period of pregnancy, the development of complications such as retinal hemorrhage or its detachment is possible. In such situations, you will need an urgent consultation with an ophthalmologist and subsequent treatment.

Sometimes vision during pregnancy may deteriorate somewhat, even if you have not experienced eye problems before: this happens especially often with preeclampsia and anemia. Quite often, women note dryness and irritation of the eyes, as well as “flickering flies”, which is usually associated with changes in blood pressure.

by the most serious complication is retinal dystrophy. Due to sudden changes in intraocular pressure during attempts, there may be serious change in the fundus, retinal detachment and other complications up to complete loss of vision. To avoid this, you should see your optometrist regularly. If the examination reveals signs of retinal dystrophy, you may be shown laser coagulation, after which delivery will be possible naturally.

Ophthalmic examination and management of pregnancy

In some cases, your OB/GYN will recommend that you undergo a comprehensive ophthalmological examination, which, in case of diseases, will help doctors develop optimal tactics for managing pregnancy. Typically, this examination includes:

• echography;
• visiometry;
• ophthalmoscopy;
• ophthalmometry;
• examination of the fundus and retina;
• a number of biomicroscopic studies.

If you have ophthalmic pathologies, management of pregnancy should be carried out with regular observation by an ophthalmologist. It is also worth considering that a number of eye diseases can be inherited by your unborn baby. In this case, it is advisable to consult a geneticist.

How is childbirth going?

Childbirth with pathologies of the organs of vision can take place both naturally and by caesarean section. If the disease does not proceed in a pronounced form, the fetus feels good, and the ophthalmologist has issued an appropriate conclusion, you are not contraindicated natural childbirth. Often in the process of natural childbirth, it becomes necessary to reduce the period of attempts, for this obstetric forceps are used.

Caesarean section in without fail should be performed for retinal detachment later dates pregnancy or directly in the process of delivery. Also, natural childbirth is contraindicated for women who have undergone previous retinal surgery. Other indications for caesarean section are a high degree of myopia and increased intraocular pressure.

Prevention of ophthalmic diseases

1. To prevent complications of eye diseases during pregnancy, you may be prescribed vitamin therapy, calcium supplements, as well as mandatory dynamic surveillance at the ophthalmologist.
2. If you are wearing contact lenses, then during pregnancy it is recommended to switch to glasses, which will reduce the risk of developing inflammatory process and dry eye syndrome.
3. If necessary, the doctor will select special eye drops, the use of which is not contraindicated during pregnancy. It is very important not to take medications without first consulting a specialist, since not all drugs are safe for the fetus.
4. In addition, a diet will be a good help for maintaining vision. rich in vitamins A, C, E and B2.
5. It is also recommended to regularly perform simple exercises for the eyes, to avoid prolonged sitting at the computer or in front of the TV, spend as much time as possible in the fresh air.